The relationship between oral contraceptive use and functional outcome in women with recent‐onset inflammatory polyarthritis: Results from the Norfolk Arthritis Register

Abstract

Objective. Use of oral contraceptives (OCs) may prevent the development of rheumatoid arthritis, but the influence of OC use on disease outcome is unresolved. The purpose of this study was to examine functional outcome and OC use in women with inflammatory polyarthritis (IP).Methods. The Norfolk Arthritis Register (NOAR) is an inception cohort of patients with recent-onset IP. We studied patient-reported history of OC use in 663 women who were born after 1945 and who had not used OCs during followup. OC use during followup was additionally investigated in 265 women who were <50 years old and had not undergone menopause or hysterectomy during followup. All patients were recruited to the NOAR between 1990 and 2004. Functional ability was assessed using the Health Assessment Questionnaire (HAQ), with adjustment for age at symptom onset.Results. The median followup was 4.9 years. In the investigation analyzing OC use before symptom onset, patients who had used OCs before symptom onset had lower HAQ scores throughout followup than patients who had not taken OCs before symptom onset (difference in score at 5-year followup ؊0.35; 95% confidence interval [95% CI] ؊0.51, ؊0.19). Patients who were taking OCs at baseline had lower HAQ scores over time than women who were not taking OCs at baseline but had previously done so (mean difference ؊0.21; 95% CI ؊0.40, ؊0.02). In the investigation analyzing OC use during followup, OC use during followup was associated with lower HAQ scores over time than no OC use during followup (mean difference ؊0.06; 95% CI ؊0.16, 0.03); however, this was only significant for women with moderate or severe functional disability at the previous assessment (mean difference ؊0.23; 95% CI ؊0.40, ؊0.07). Further adjustment for potential confounders and exclusion of hormone replacement therapy users had little impact.Conclusion. OC use is generally associated with a beneficial functional outcome in IP, and use before and at symptom onset appeared to have the most consistent benefit.

Association Between the Use of Oral Contraceptives and Patient‐Reported Outcomes in an Early Arthritis Cohort

“…The association of OC use with the reported PROs was almost identical for past and current users, although half of the past users were older than age 50 years and may not have used OCs for several years. The results of a study by Camacho et al concerning functional outcomes are in agreement with our data; Camacho et al also reported an association between OC use prior to symptom onset and HAQ values at baseline and during a 5‐year followup . The findings on RAID, RADAI, and PROFAD scores cannot be compared with data from the literature since, thus far, no data have been reported concerning the influence of OCs on PROs in arthritis, except for functional outcomes.…”

“…A recent meta‐analysis could not confirm an OC‐mediated protective effect . Data from the Norfolk Arthritis Register showed that the use of OCs at symptom onset and even years before was associated with beneficial functional outcomes over 5 years . In contrast, long‐term radiologic and functional outcomes after 12 years were not significantly influenced by the use of OCs in an RA cohort from the Netherlands .…”

Early menopause and severity of rheumatoid arthritis in women older than 45 years

“…Variances in methods, doses, and types of OC, as well as population differences, have been proposed to explain some of these controversies. It has been suggested that OCs alter the course of RA, instead of acting as a predictor, and are associated with a milder type of disease and less disability [12,13]. In a previous study, we did not find any impact of a history of OC use on the risk of RA [2].…”

“…A recent study [12] suggested that OC use is associated with mild RA and demonstrated a reduction of disability, measured by HAQ over time, in former OC users, compared with nonusers. Furthermore, current OC users had lower HAQ scores at baseline and over time than did previous users.…”

Hormone replacement and contraceptive therapy in autoimmune diseases

“…Despite this need, there is a paucity of literature on the safety of contraceptives in rheumatoid arthritis. Recent data from the Norfolk Arthritis Register (NOAR), an inception cohort of patients with recent-onset inflammatory polyarthritis, showed that OC use is associated with a beneficial functional outcome [66]. Another cohort study reported non-significant improvement in measures of disease activity and damage in 54 OC users with rheumatoid arthritis compared to 58 non-users [67].…”